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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Idmundo on May 10, 2004, at 11:37:54
hello to all. Well, I thought I had found the holy grail of ADs in Nardil, in spite of the weight gain and anorgasmia, Nardil was all I'd hoped it would be, and then some. I had checked up on it and found that it was highly indicated for Avoidance problems, depression and anxiety. Worked like the proverbial charm..for about a month. I've been through about all of them, and found I could function on Wellbutrin SR and klonazepam, but still stayed anhedonic most of the time. Anyway, unless someone found a way to revitalize a faded response to Nardil or perhaps discovered that another AD replaced it (Parnate?) I guess I'll have to go back to the disthymic shadow world from whence I emerged with the magic of Nardil. On the bright side, it looks as if the selegiline transdermal system (patch)may be in the pipes this year, under the new name of EmSaM:
Transdermal Selegiline in Major Depression:
A Double-Blind, Placebo-Controlled,
Parallel-Group Study in Outpatients
Bodkin JA, Amsterdam JD.
Am J Psychiatry 2002 Nov 1;159(11):1869-1875ABSTRACT
OBJECTIVE: The authors investigated the efficacy and safety of transdermal selegiline in adult outpatients with major depressive disorder. METHOD: Following a 1-week placebo lead-in, 177 adult outpatients with major depressive disorder were randomly assigned to receive transdermal selegiline (20 mg applied once daily by means of a 20-cm(2) patch) (N=89) or placebo (N=88) for 6 weeks. The patients followed a tyramine-restricted diet during the medication trial and for 2 weeks after completion of treatment. Response to medication or placebo was measured by using the 17-item and 28-item versions of the Hamilton Depression Rating Scale, the Montgomery-Asberg Depression Rating Scale, and the Clinical Global Impression (CGI) severity and improvement measures. RESULTS: Greater improvement was observed after 6 weeks in patients treated with transdermal selegiline than in those given placebo according to all measures. A statistically significant difference between drug and placebo was seen in Hamilton depression scale and Montgomery-Asberg Depression Rating Scale scores as early as week 1 of treatment. There were no differences in the adverse event profile of the patients given selegiline and those given placebo with the exception of application-site reactions, which were more common with the selegiline transdermal system. No orthostatic hypotensive or hypertensive reactions were observed. CONCLUSIONS: Transdermal selegiline (20 mg applied once daily by means of a 20-cm(2) patch) administered for 6 weeks was an effective and well-tolerated treatment for adult outpatients with major depression. The typical side effects commonly seen with traditional monoamine oxidase inhibitor antidepressants were not observed.
Posted by harryp on May 10, 2004, at 11:42:43
In reply to Nardil...great while it lasted?, posted by Idmundo on May 10, 2004, at 11:37:54
Make sure you've gone up to the max dose of the Nardil, and then try augmenting with lithium. Or you could try Parnate.
Do make sure that you've maxed out on the Nardil--the old prescribing info isn't accurate, and an effective dose if often higher than what is listed.
I'm not too optimistic about the Selegiline patch, I haven't seen any evidence that selegiline can compare to Nardil or Parnate as an AD.
Posted by Idmundo on May 10, 2004, at 12:02:10
In reply to Nardil...great while it lasted?, posted by Idmundo on May 10, 2004, at 11:37:54
Thanks H. I'm up to 90mg, and as far as I know that's the max. Have you revived Nardil's effect with lithium? I don't know if my PCP would go for this, it was hard enough to get Nardil prescribed. Another factoid here: I actually started off on Nardil by ordering directly over the Net from a European supplier before finally getting a prescription. I don't know if theirs was Parke-Davis or another maker. Europe is much better regulated on purity and strength, IMO. I'll go back and check that..it may be significant.
Posted by harryp on May 10, 2004, at 20:32:28
In reply to Re: Nardil...great while it lasted?, posted by Idmundo on May 10, 2004, at 12:02:10
According to Bernstein's *Drug Therapy in Psychiatry*, lithium carbonate can be used to augment any AD. I have heard the best results when it is used with Parnate, though. You might want to try Parnate, just make sure you wait 2 weeks after stopping Nardil before starting Parnate.
This is the end of the thread.
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